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Bonasoni MP, Comitini G, Cavicchioni O, Barbieri V, Dalla Dea G, Palicelli A, Aguzzoli L. Prenatal Detection of Vesico-Allantoic Cyst: Ultrasound and Autopsy Findings. Fetal Pediatr Pathol 2022; 42:498-505. [PMID: 36369825 DOI: 10.1080/15513815.2022.2143250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction: The vesico-allantoic cyst is a communication between the fetal bladder and the allantois through a patent urachus.Case Report: We describe a 17-week of gestational age (WGA) fetus with a 40 x 30 mm vesico-allantoic cyst. At 19 WGA, ultrasound (US) detected bilateral dilatation of renal pelvis (5-6 mm), hydroureters, and hypospadias. Amniotic fluid, umbilical cord flow, and fetal biometry were regular. Due to uncertain prognosis, the parents opted for legal termination of pregnancy. Autopsy confirmed the prenatal findings, also revealing intestinal malrotation and Meckel's diverticulum.Discussion/Conclusion: Probably an initial urinary tract obstruction occurred, not yet affecting the amniotic fluid volume, but evident as pyelectasis. This case highlights the possibility that genito-urinary and intestinal anomalies may be found in association with the vesico-allantoic cyst.
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Affiliation(s)
| | - Giuseppina Comitini
- Department of Obstetrics & Gynaecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ottavia Cavicchioni
- Department of Obstetrics & Gynaecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Veronica Barbieri
- Medical Genetics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics & Gynaecology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Kwon JY, Pyeon SY. Prenatally Ruptured Patent Urachus: A Case Report and Review of Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1621. [PMID: 36363578 PMCID: PMC9694912 DOI: 10.3390/medicina58111621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 07/08/2024]
Abstract
Patent urachus is a type of urachal anomaly in which the urachus does not tail off but remains connected to the bladder in the umbilicus. The prevalence of patent urachus is very low. Herein, we report a case of patent urachus ruptured and exposed to amniotic fluid in utero. In this case, the size decreased after the second trimester, which was thought to be due to rupture in utero. After delivery, patent urachus was confirmed by inserting a foley catheter, which runs through a ruptured cyst on umbilical cord insertion. The day after delivery, the neonate underwent surgical excision of the urachal cyst and closing umbilicus. The mechanism of patent urachus rupture is unknown. As the fetus matures, it is thought that the higher intravesical pressure may affect the rupture of the cyst. Patent urachus could be ruptured in the uterus spontaneously, and surgical correction is needed. Therefore, prenatal differential diagnosis is important.
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Affiliation(s)
- Ji-Young Kwon
- Department of Medicine, Graduate School, Kyung Hee University, 26 Kyungheedau-ro, Dongdaemun-gu, Seoul 02447, Korea
| | - Seung-Yeon Pyeon
- Department of Medicine, Graduate School, Kyung Hee University, 26 Kyungheedau-ro, Dongdaemun-gu, Seoul 02447, Korea
- Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea
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Chien CW, Chen KJ, Lai JY, Chao AS. Patent urachus or bladder exstrophy occulta? A case of prenatally disappeared umbilical cord cyst. Urol Case Rep 2021; 39:101772. [PMID: 34377676 PMCID: PMC8329479 DOI: 10.1016/j.eucr.2021.101772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
We are reporting an umbilical cyst detected at early trimester which mimicking bladder exstrophy occulta. A 3-cm umbilical cord cyst and a slight ventrally located urinary bladder beneath the cord insertion site was detected at 14th gestational weeks, which decreased in size and disappeared at 28th week. A term female neonate born with a 2-cm defect over the base of the umbilical cord, revealed a patent urachal fistula, and a part of the herniated urinary bladder. Detection of a vanished umbilical cord cyst has to keep aware of, making an immediate definite diagnosis and management of urachal anomaly.
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Affiliation(s)
- Chih-Wei Chien
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei City, 236, Taiwan
| | - Kuan-Ju Chen
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei City, 236, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou) and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, 236, Taiwan.,Department of Pediatric Surgery, Chang Gung Memorial Hospital (Linkou) and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynecology, New Taipei Municipal Tucheng Hospital, New Taipei City, 236, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital (Linkou) and Chang Gung University College of Medicine, Taoyuan, 333, Taiwan
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Mallmann MR, Mack-Detlefsen B, Reutter H, Pohle R, Gottschalk I, Geipel A, Berg C, Boemers TM, Gembruch U. Isolated bladder exstrophy in prenatal diagnosis. Arch Gynecol Obstet 2019; 300:355-363. [PMID: 31115647 DOI: 10.1007/s00404-019-05193-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Isolated classic bladder exstrophy (CBE) is the most common variant of the bladder-exstrophy-epispadias complex (BEEC). The BEEC represents a spectrum ranging from isolated epispadias over CBE to the most severe form, cloacal exstrophy. We report on a series of 12 cases with CBE diagnosed prenatally and illustrate the spectrum of prenatal ultrasound findings with comparison to prior published reports on this entity. METHODS This was a retrospective study involving 12 fetuses with CBE at two large tertiary referral centers in Germany over a 14-year period (2004-2018). RESULTS Median diagnosis was made with ultrasound in 24 + 5 (IQR25,75: 21 + 2, 29 + 0) weeks of gestation. All fetuses presented with the pathognomonic findings non-visualization of the fetal bladder and protruding abdominal mass below the umbilical cord insertion. All fetuses showed normal kidney anatomy and normal amniotic fluid throughout pregnancy. Epispadia was visible prenatally on ultrasound in 6/8 male fetuses. 1/12 Parents opted for termination of pregnancy, 11/12 fetuses were live born and received reconstructive surgery. CONCLUSIONS Isolated CBE is an extremely rare prenatal sonographic finding. Prenatal diagnostics should exclude additional malformations within the spectrum of cloacal malformations.
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Affiliation(s)
- Michael R Mallmann
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany.
| | - Birte Mack-Detlefsen
- Department of Pediatric Surgery and Pediatric Urology, Children'S Hospital of Cologne, Cologne, Germany
| | - Heiko Reutter
- Department of Neonatology and Pediatric Intensive Care, University of Bonn, Bonn, Germany
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Rebecca Pohle
- Department of Pediatric Surgery and Pediatric Urology, Children'S Hospital of Cologne, Cologne, Germany
| | - Ingo Gottschalk
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
- Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | - Thomas M Boemers
- Department of Pediatric Surgery and Pediatric Urology, Children'S Hospital of Cologne, Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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Antomarchi J, Moeglin D, Laurichesse H, Combourieu D, Bigi N, Maisonneuve E, Legac P, Althuser M, Delotte J, Jouannic JM, Bongain A. The Pubic Diastasis Measurement, a Key Element for the Diagnosis, Management, and Prognosis of the Bladder Exstrophy. Fetal Diagn Ther 2018; 45:435-440. [PMID: 30231253 DOI: 10.1159/000492817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of measuring the fetal pubic diastasis (PD) distance on antenatal ultrasound in normal fetuses and to compare it to fetuses with bladder exstrophy. METHODS Firstly, a prospective multicentric study was conducted to determine the feasibility of the PD ultrasound measurement during the second half of pregnancy. Secondly, data from a single center were used to develop a nomogram for PD values in normal fetuses. Thirdly, retrospective PD measurements were collected from fetuses with bladder exstrophy, diagnosed in seven French Multidisciplinary Centers for Prenatal Diagnosis (MCPDs). RESULTS Operators from several MCPDs examined 868 fetuses and found that overall PD ultrasound measurement was feasible in 71% of cases and that the ossification of pubic points increased to be always visible from 27 weeks of gestation onward. Performed in a single center by a referring operator on 1,539 fetuses, the feasibility reached 94.74%. Both set of measurements were concordant (mean PD distance value of 5.42 ± 1.8 mm). Interestingly, all 23 fetuses with bladder exstrophy showed a significantly larger PD distance (mean 15.74 ± 3.9 mm). CONCLUSION PD measurement in the fetus is feasible and reliable in the second half of gestation and can be used to support the antenatal diagnosis of bladder exstrophy with PD values exceeding 10 mm.
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Affiliation(s)
- Julie Antomarchi
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France,
| | - Daniel Moeglin
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
| | | | - Danièle Combourieu
- Hôpital Femme-Mère-Enfants, Centre Pluridisciplinaire Diagnostic Prénatal, Lyon-Bron, France
| | - Nicole Bigi
- CRHU Carémeau-Nîmes, Service Gynécologie Obstétrique, Nîmes, France
| | - Emeline Maisonneuve
- Université Pierre et Marie Curie, Hôpital Armand-Trousseau, Service de Médecine Fœtale, Paris, France
| | - Pascale Legac
- CRHU Carémeau-Nîmes, Service Gynécologie Obstétrique, Nîmes, France
| | - Marc Althuser
- CHU Grenoble, Centre de Diagnostic Prénatal, Grenoble, France
| | - Jérome Delotte
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
| | - Jean-Marie Jouannic
- Université Pierre et Marie Curie, Hôpital Armand-Trousseau, Service de Médecine Fœtale, Paris, France
| | - André Bongain
- Université Nice Côte d'Azur, CHU Nice-Archet II, Service Gynécologie Obstétrique, Nice, France
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Srisupundit K, Mahawong P, Charoenratana C, Tongsong T. Prolapsed bladder following rupture of patent urachal cyst, mimicking bladder exstrophy: a case report and literature review. J Med Ultrason (2001) 2018; 45:529-533. [PMID: 29318419 DOI: 10.1007/s10396-017-0856-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
A 26-year-old pregnant woman was diagnosed with fetal bladder prolapse following rupture of a patent urachus/urachal cyst, based on the finding of cyst disappearance with replacement with an infra-umbilical, extra-abdominal solid soft-tissue mass, mimicking bladder exstrophy. The neonatal findings confirmed the prenatal diagnosis. The baby was healthy and had a successful surgical correction. This report provides clues to differentiating ruptured bladder prolapse from bladder exstrophy as follows: (1) well-documented urachal cyst with urine-filled mass in the early gestation, (2) development of solid soft-tissue mass shortly after disappearance of the urachal cyst, and (3) no other structural abnormalities (bladder exstrophy is usually associated with abnormal genitalia, epispadias, or pubic diastasis). This study underlines the differentiation between the two entities because of the vast difference in prognosis, management, and proper counseling.
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Affiliation(s)
- Kasemsri Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Phitsanu Mahawong
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Cholaros Charoenratana
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Theera Tongsong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Riddell JVB, Houle AM, Franc-Guimond J, Barrieras D. Prenatal vesico-allantoic cyst outcome - a spectrum from patent urachus to bladder exstrophy. Prenat Diagn 2015; 35:1342-6. [DOI: 10.1002/pd.4702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 11/09/2022]
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Rasteiro C, Ramalho C, Loureiro T, Pereira J, Matias A. Bladder emptying into an umbilical cord cyst: prenatal sonographic sign of allantoic cyst with patent urachus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:239-240. [PMID: 23239551 DOI: 10.1002/uog.12361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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9
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Diagnostic anténatal et prise en charge des extrophies vésicales isolées. ACTA ACUST UNITED AC 2010; 38:624-30. [DOI: 10.1016/j.gyobfe.2010.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 02/28/2010] [Indexed: 11/22/2022]
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Zangen R, Boldes R, Yaffe H, Schwed P, Weiner Z. Umbilical cord cysts in the second and third trimesters: significance and prenatal approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:296-301. [PMID: 20131340 DOI: 10.1002/uog.7576] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES This study was carried out to determine the prognosis, and the clinical approach, in fetuses with umbilical cord cysts, during the second and third trimesters of gestation, according to our experience and data in the current literature. METHODS We identified 10 fetuses with umbilical cord cysts that were diagnosed during the second and third trimesters of pregnancy at three referral centers. All underwent detailed ultrasound evaluation at the time of diagnosis and during follow-up. Prenatal karyotype testing was offered to all women. A MEDLINE review of the literature published from 1980 to 2009 was carried out to identify previous studies and case reports of fetuses with umbilical cord cysts. RESULTS In our series of 10 cases, significant additional abnormalities were observed in two during a detailed sonogram. In one case, trisomy 18 was diagnosed, leading to pregnancy termination, and in the other case a neonate with heart defects and a normal karyotype was born. These results differ from those reported in the literature, in which the association between second- and third-trimester umbilical cord cysts and fetal anomalies ranged from 38 to 100%. CONCLUSIONS In our study, as in other publications, an association was found between the presence of second- and third-trimester umbilical cord cysts and fetal anomalies. The strong association between second- and third-trimester umbilical cord cysts and aneuploidy in the literature seems to be biased, mainly because of the tendency to report abnormal cases. When these findings are accompanied by additional sonographic abnormalities, the association with aneuploidy is clear and should be an indication for fetal karyotype testing.
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Affiliation(s)
- R Zangen
- Department of Obstetrics and Gynecology, Bikur Holim Hospital, Jerusalem, Israel.
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Bonilla F, Raga F, Villalaiz E, Osborne N, Castillo JC, Bonilla-Musoles F. Umbilical cord cysts: evaluation with different 3-dimensional sonographic modes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:281-285. [PMID: 20103800 DOI: 10.7863/jum.2010.29.2.281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The purpose of this series was to determine whether the use of different 3-dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. METHODS Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2-dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer-aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. RESULTS Three-dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. CONCLUSIONS Three-dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.
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Affiliation(s)
- Francisco Bonilla
- Department of Obstetrics and Gynecology, Valencia School of Medicine, Blasco Ibañez 17, 46011 Valencia, Spain.
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